Debridement

Primary purposes for debridement are to:

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Control and remove infectious materials  

and/or biofilm

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 Interrupt the cycle of the chronic wound so 

that protease and cytokine levels more closely 

resemble those of the acute wound

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 Reduce bioburden by removing the necrotic 

tissue that supports the growth of bacteria

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 Facilitate visualization of the wound edges 

and base for accurate assessment

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Overview

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Causes of Necrotic Burden

Skin Failure

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Skin failure happens when skin and underlying tissue die due 

to hypoperfusion, concurrent with severe dysfunction or failure 

of other organ systems.  Determining skin failure is currently 

done by gross examination of muscle mass, subcutaneous 

tissue thickness, wound granulation, and tissue necrosis. 

In addition, stratifying skin failure according to the patient’s 

medical condition can be useful in planning interventions  

and setting treatment goals.  

Skin failure can be typified as acute, chronic and end-stage. 

Acute skin failure occurs when skin and underlying tissue die  

due to hypoperfusion concurrent with a critical illness.  Mortality 

rates range from 33% within 30 days to 73.3% within 1 year of 

onset of skin failure in the intensive care population.  

Chronic skin failure is an event in which skin and underlying 

tissue die due to hypoperfusion concurrent with a chronic 

disease state. It typically happens more steadily over time, 

and in older individuals.  Multiple co-morbidities combined 

with other age-related declines can accelerate degeneration. 

Deterioration of internal organs can manifest in the external 

organ of skin.

End-stage skin failure occurs when skin and underlying tissue  

die due to hypoperfusion concurrent with the end of life.

Necrotic Tissue and Necrotic Burden

Necrotic or avascular tissue is the result of an inadequate 

blood supply to the tissue in the wound area.  It contains dead 

cells and debris that is a consequence of the dying cells.

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There are different types of necrotic tissue including eschar 

and slough.  Avascular tissue exposed to the air will form a 

hard black crust known as 

eschar. If kept moist, avascular 

tissue will appear brown, yellow or gray and soft, flimsy or 

stringy.  This tissue is called 

slough.  Slough is fibrinous 

tissue consisting of 

fibrin, bacteria, intact leucocytes, 

cell debris, serous exudates and DNA.  After eschar is 

debrided, slough may be present as the wound is not 

completely clean. Thereafter, if a moist wound environment 

is not maintained, continued exposure to air may dessicate 

remaining slough, causing eschar to reform.

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Necrotic burden is the combination of necrotic tissue, 

excess exudate and high levels of bacteria present in 

dead tissue that accumulate in chronic wounds.  Necrotic 

burden creates an altered cellular environment (elevated 

pH, proteases, biofilm, free radicals) which causes a 

cascading effect that can prolong the inflammatory 

phase, obstruct wound contraction and impede the 

reepithelialization

 

process.

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